The scientific context: what is HBSC telling us? Socioeconomic determinants of healthy eating habits and physical activity among adolescents The scientific context: what is HBSC telling us? Candace Currie HBSC International Coordinator University of Edinburgh

HBSC Forum Background Paper ‘Overweight and obesity in children and adolescents and the role of healthy eating, physical activity and socioeconomic status’ Ellen Haug, Oddrun Samdal, Antony Morgan, Ulrike Ravens-Sieberer and Candace Currie

HBSC reporting of obesity related data HBSC International report: ‘Young people’s health in context’ (2004) Numerous scientific papers from the HBSC international research network (listed on www.hbsc.org) .

HBSC scope Includes physical, emotional and social health and well-being Measures comprehensive range of behaviours that both risk and promote health Places health and behaviour of young people in social and developmental context

Social and developmental context of adolescent health and behaviour Socioconomic profile of country Family socioeconomic status Family structure and relationships School environment and relationships Peer group and relationships Individual maturation: pubertal development

HBSC surveys Conducted every four years at same time in all countries with common standardised instrument Nationally representative samples of 11,13 and 15 year olds 1st survey in 1983/4 in 3 countries; 7th survey in 2005/6 in 40 countries European region and North America

HBSC countries 2005/6

The study of obesity in HBSC Optional topic in 1997/98 survey Self-reported height and weight mandatory questions in 2001/2 and 2005/6 surveys HBSC produces only comparable cross-national data on BMI among adolescents across European region

Obesity: conceptualisation in HBSC A measure of a young person’s physical condition with implications for health and well-being With behavioural determinants and outcomes With social and emotional causes and consequences Influenced by individual and environmental factors

Focus of Forum background paper Overweight and obesity Eating habits Physical activity Gender Socieconomic status

Wider HBSC focus Overweight and obesity Eating habits Physical activity Body image Weight control behaviour Gender Socieconomic status

‘HBSC obesity triangle’ Eating behaviour gender Socioeconomic factors obesity Mental health Physical activity Environmental factors (social and physical)

WHO/HBSC Forum series focus Social and economic determinants and sources of inequality in adolescent health

Variations in life circumstances for adolescents across Europe Countries vary considerably in the extent of young people living in low affluence households Countries vary considerably in family structures in which young people are living

% young people reporting low family affluence (FAS) (Source: Young People’s Health in Context (2004)) Ukraine Norway

Family structure across HBSC countries (Source: Young People’s Health in Context (2004))

Gender inequalities There are consistent and significant gender differences across all countries in elements of the ‘obesity triangle’ Levels of physical activity Consumption of obesogenic foods Prevalence of overweight

% 15 year old boys meeting physical activity guidelines (Source: Young People’s Health in Context (2004))

% 15 year old girls meeting physical activity guidelines (Source: Young People’s Health in Context (2004))

% 15 year olds boys drink soft drinks daily (Source: Young People’s Health in Context (2004))

% 15 year olds girls drink soft drinks daily (Source: Young People’s Health in Context (2004))

% overweight 15 year old boys (Source: Young People’s Health in Context (2004))

% overweight 15 year old girls (Source: Young People’s Health in Context (2004))

Selected evidence of socioeconomic inequalities in the ‘HBSC obesity triangle’ Overweight higher among children from lower SES backgrounds (11 and 13 year olds) Aspects of poor eating are more common among lower SES groups (eg low fruit consumption) High levels of TV watching more common among lower SES groups

Cross-national variation in socioeconomic inequalities in the ‘HBSC obesity triangle’ High consumption of soft drinks: more common among lower SES groups in Northern, Southern and Western Europe more common in higher SES groups in Central and Eastern Europe

% 15 year old boys report ‘too fat’ (Source: Young People’s Health in Context (2004))

% 15 year old girls report ‘too fat’ (Source: Young People’s Health in Context (2004))

% overweight 15 year old boys (Source: Young People’s Health in Context (2004))

% overweight 15 year old girls (Source: Young People’s Health in Context (2004))

Obesity not the only epidemic ‘Epidemic’ of cheap, nutritionally poor, food being produced in a globalised market with hidden environmental costs

Obesity not the only epidemic ‘Epidemic’ of nutritionally poor and obesogenic food consumption by poor children in rich industrialised countries

Obesity not the only epidemic ‘Epidemic’ of reduced opportunities for children and adolescents (especially girls) to be physically active, enjoyably and safely

Obesity not the only epidemic ‘Epidemic’ of ‘body judgementalism’ by the media, by peers, by clinicians and by themselves that is putting young people’s mental well-being at risk

Obesity: the need for a broad perspective in our discussions at this forum we need to examine obesity in a very broad context so that efforts in prevention and intervention are successful and sensitive to the life circumstances and preoccupations of young people growing up in Europe today

What HBSC has to offer Data on key aspects of adolescent health their social and economic determinants in adolescents A conceptual framework for health improvement among adolescents that takes into account the wider social and developmental context

‘HBSC obesity triangle’ Eating behaviour gender Socioeconomic factors obesity Mental health Physical activity Environmental factors (social and physical)

Acknowledgements Members of the HBSC international research network WHO Regional Office for Europe